title: Magnetic resonance imaging correlates of physical disability in relapse onset multiple sclerosis of long disease duration.
abstract: BACKGROUND
  Understanding long-term disability in multiple sclerosis (MS) is a key goal of research; it is relevant to how we monitor and treat the disease.
  
  
  OBJECTIVE
  The Magnetic Imaging in MS (MAGNIMS) collaborative group sought to determine the relationship of brain lesion load, and brain and spinal cord atrophy, with physical disability in patients with long-established MS.
  
  
  METHODS
  Patients had a magnetic resonance imaging (MRI) scan of their brain and spinal cord, from which we determined brain grey (GMF) and white matter (WMF) fractional volumes, upper cervical spinal cord cross-sectional area (UCCA) and brain T2-lesion volume (T2LV). We assessed patient disability using the Expanded Disability Status Scale (EDSS). We analysed associations between EDSS and MRI measures, using two regression models (dividing cohort by EDSS into two and four sub-groups).
  
  
  RESULTS
  In the binary model, UCCA (p < 0.01) and T2LV (p = 0.02) were independently associated with the requirement of a walking aid. In the four-category model UCCA (p < 0.01), T2LV (p = 0.02) and GMF (p = 0.04) were independently associated with disability.
  
  
  CONCLUSIONS
  Long-term physical disability was independently linked with atrophy of the spinal cord and brain T2 lesion load, and less consistently, with brain grey matter atrophy. Combinations of spinal cord and brain MRI measures may be required to capture clinically-relevant information in people with MS of long disease duration.
authors.affiliation: Institute of Neurology, University College London, UK.
authors.forename: H
authors.initials: H
authors.lastname: Kearney
authors.forename: M A
authors.initials: MA
authors.lastname: Rocca
authors.forename: P
authors.initials: P
authors.lastname: Valsasina
authors.forename: L
authors.initials: L
authors.lastname: Balk
authors.forename: J
authors.initials: J
authors.lastname: Sastre-Garriga
authors.forename: J
authors.initials: J
authors.lastname: Reinhardt
authors.forename: S
authors.initials: S
authors.lastname: Ruggieri
authors.forename: A
authors.initials: A
authors.lastname: Rovira
authors.forename: C
authors.initials: C
authors.lastname: Stippich
authors.forename: L
authors.initials: L
authors.lastname: Kappos
authors.forename: T
authors.initials: T
authors.lastname: Sprenger
authors.forename: P
authors.initials: P
authors.lastname: Tortorella
authors.forename: M
authors.initials: M
authors.lastname: Rovaris
authors.forename: C
authors.initials: C
authors.lastname: Gasperini
authors.forename: X
authors.initials: X
authors.lastname: Montalban
authors.forename: J J G
authors.initials: JJ
authors.lastname: Geurts
authors.forename: C H
authors.initials: CH
authors.lastname: Polman
authors.forename: F
authors.initials: F
authors.lastname: Barkhof
authors.forename: M
authors.initials: M
authors.lastname: Filippi
authors.forename: D R
authors.initials: DR
authors.lastname: Altmann
authors.forename: O
authors.initials: O
authors.lastname: Ciccarelli
authors.forename: D H
authors.initials: DH
authors.lastname: Miller
authors.forename: D T
authors.initials: DT
authors.lastname: Chard
mesh_terms: D001284:Atrophy / Q000473:pathology; D001921:Brain / Q000473:pathology; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D020528:Multiple Sclerosis, Chronic Progressive / Q000150:complications* / Q000473:pathology*; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000150:complications* / Q000473:pathology*; D013116:Spinal Cord / Q000473:pathology
keywords: Atrophy; MRI; brain lesion load; disability; multiple sclerosis; spinal cord